Category: 1. Aorta Ultrasound indications and Preparation

Patient preparation

• The patient should be supine with the head of the bed flat.
• Have patient bend knees, if possible, to help relax the abdominal muscles.

Ultrasound machine preparation

• Transducer: 
  • Use a Curvilinear probe to examine the abdominal aorta.
  • Use a Phased Array probe to obtain the suprasternal notch view.
• Preset:
  • Abdominal Setting to view the abdominal aorta. Starting Depth should be around 10-15cm.
  • Cardiac Setting for the suprasternal view. Starting Depth should be around 10cm.
• Ultrasound Machine Placement:
  • Place the machine on the patient’s right side, so you can scan with your right hand and manipulate the ultrasound buttons with your left hand.

You should conduct an ultrasound of the aorta whenever you suspect abdominal aortic aneurysm (AAA) or aortic dissection.

• The US preventative task force recommends a one-time screening for AAA in male patients between the ages of 65-75 who have ever smoked.
• Male sex and advanced age (≥ 65) are considered risk factors for both AAA and aortic dissection. However, keep in mind that patients with congenital risk factors will commonly present before age 40 (Lederle, Howard).

Below is a table to keep in mind when considering Abdominal Aortic Aneurysm (AAA) or Aortic Dissection:

	Abdominal Aortic Aneurysm (AAA)	Aortic Dissection
Pain quality	Constant, intense abdominal, back, pelvic, or flank pain that may radiate to buttocks, groin, or thighs	Acute-onset, severe chest or back pain with ripping/tearing/sharp or stabbing quality
Risk factors	Smoking  Hypertension Hypercholesterolemia Atherosclerosis & coronary artery disease	Acquired: Hypertension Smoking Third Trimester Pregnancy Amphetamines, cocaine Congenital: Connective tissue disease (Ehler’s-Danlos, Marfan’s) Bicuspid aortic valve
Physical Findings	Pain, hypotension, pulsatile abdominal mass (ruptured AAA classic triad) Systolic abdominal bruit Signs of GI bleeding or retroperitoneal hemorrhage	Syncope, hypotension/shock Pulse deficit, systolic BP differential between limbs Aortic regurgitation murmur Neurologic Deficits